1. Guilt, self-blame. Except when the patient is seriously depressed, blaming oneself and expressing guilt feelings are difficult to do. At times, the only clue is an over-defensiveness, an anxious displacement of blame and responsibility to somebody else. At other times, a series of expiatory acts or obvious attempts of undoing and great anxiety over anticipated painful consequences (“punishment”) are the indicators.

2. Anger and hostility when directed against love objects. They find it easier to recognize patterns of hostility towards other people. Towards loved ones the great fear is that of destroying the relationships if one admits hate impulses. When such are recognized, guilt feelings are considerable; reaction-formation, in the form of nurturance, sympathy and pity are utilized to deny hostile thoughts.

One must distinguish between transference and transference. like phenomena. Like some of my colleagues, psychiatric residents and workers in allied fields in the Philippines who are familiar with psychoanalytic theory and technique, I have often wondered if Filipino patients have a “built-in” kind of transference for any benevolent authority figure who provides them with abundant narcissistic gratification through intense individual attention. The readiness to be dependent, a propensity to eroticize almost every situation and the presence of cultural practices which sanction or promote these tendencies will conceivably foster transference. I have heard colleagues remark of a patient: ‘Transference appeared after four or five meetings.” The first two or three meetings were spent by the patient in describing his (her) problems; now he (she) is asking many personal questions about the therapist. This curiosity about the therapist is interpreted by the latter as evidence of a beginning deep attachment. Perhaps the period of training of the Filipino psychiatrist spent with American patients who manifest transference by expressing great interest in the therapist’s personal life may contribute in part to the above interpretation. Actually, in Filipino culture, curiosity about another individual’s personal life precedes entry into any relationship with him.

During the initial stages, the productivity of the patient and his over-all willingness to get involved in treatment depend on the urgency of symptoms and on his ability to trust his feelings with a stranger. Most of these Filipino patients, especially those who have reacted with surprise to the psychiatric referral, manifested sonic shyness, embarrassment, shame, fear, or distrust in the initial part of the hour and had to be reassured and helped to facilitate their verbalizations. In general, however, they are able to master their anxiety and actually enjoy the interview. This is not to say that they then proceed to jump into a discussion of their emotional problems. But they are able to handle their discomfort, becoming less guarded and more responsive. The frequent complaint of Western colleagues about Oriental patients in therapy that the patients are extremely reluctant to talk and sometimes impossible to communicate with does not seem to apply with this group of Filipino patients. Perhaps, the fact that the therapist belongs to the same nationality is a crucial factor with Filipino patients.

When I was undergoing residency training in psychiatry with supervision in psychotherapy in the late 50’s in the United States, the criterion for a good therapist was that he be able to keep his patient coming for a long time. It was a testimony to one’s ability to “relate” to patients and to keep them “motivated.” The experiences of my first year of practice with Filipino patients brought puzzlement and some dismay and serious doubt about the applicability of a Western method to another culture. These reactions came ‘in the face of the observation that the majority of patients after being relieved of their acute distress were not interested in finding out more about themselves. Minor disparities in cultural styles and communication between the Filipino patient and his Western counterpart were easy enough to understand and work into the method. The massive repressive barriers which stood in the application of the method had made me and some of my colleagues ponder over the question of applicability.

There are other culturally packaged notions which the Filipino patient assumes that the therapist shares with him. These have to do with attitudes towards Sex and religion. I, being a woman, am presumed to be “soft,” expected to be sensitive and, perhaps, sentimental. I am supposed to view sexual pleasure as a male prerogative and therefore, as a woman, will be defensive, diffident, and even indifferent about discussing it.

The patient may ask the therapist, if the information is not yet known to him, whether the latter is married and has children. Depending on the answer, the patient assumes another set of cultural notions, having to do with wifely and motherly attitudes. (These questions are not likely to be asked as part of transference phenomena, although in certain contexts, they definitely are. The therapist therefore, unless he correctly appraises the situation, runs the risk of committing a faux par with the wrong interpretation.) Knowing that the therapist is married and has children, the patient may summarize his feelings with a brief, “You must know how it is.” Should the therapist answer “I don’t know exactly how it is; perhaps you had better tell me,” the patient is likely to smile and acknowledge that he, as well as the therapist, knows this is merely a device to keep him talking.